The prevalence of diabetes type 1 (T1D) in the world populations is continuously growing. Althoug... more The prevalence of diabetes type 1 (T1D) in the world populations is continuously growing. Although treatment methods are improving, the diagnostic is still symptom-based and sometimes far after onset of the disease. In this context, the aim of the study was the search of new biomarkers of the disease in red blood cells (RBCs), until now unexplored. The metabolomic and the lipidomic profile of RBCs from T1D patients and matched healthy controls was determined by NMR spectroscopy, and different multivariate discrimination models were built to select the metabolites and lipids that change most significantly. Relevant metabolites were further confirmed by univariate statistical analysis. Robust separation in the metabolomic and lipidomic profiles of RBCs from patients and controls was confirmed by orthogonal projection on latent structure discriminant analysis (OPLS-DA), random forest analysis, and significance analysis of metabolites (SAM). The main changes were detected in the levels ...
Introduction: In the context of obesity pandemic, the health care providers involved in the prima... more Introduction: In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy, and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present, there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic. Methods: We present a model of continuous, bilateral, and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system. Results: The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the managemen...
Introduction: A significant reduction in fat-free mass (FFM) following bariatric surgery (BS) has... more Introduction: A significant reduction in fat-free mass (FFM) following bariatric surgery (BS) has been reported, and adequate protein intake is recommended for FFM preservation. Current guidelines of nutritional management after BS recommend complex protein (CP) compounds. However, Roux-en-Y-gastric bypass (RYGB) has a negative impact on CP digestion, leading to protein malabsorption. At present, there is no data regarding the impact of early supplementation with short peptide-based (SPB) or hydroxy methylbutyrate (HMB)-enriched formulas on the evolution of the FFM after the BS. Aim: The aim of this study is to evaluate the effect of nutritional products based on CP, HBM-enriched, or SPB formulas on the FFM of patients that undergo RYGB. Material and methods: This is a prospective interventional study, including three groups of patients (according to the type of protein product) as candidates for BS, recruited between December 2021 and April 2022, matched by age, gender, and BMI. Al...
The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive im... more The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive impairment and later dementia), with a significant impact on the management of the disease and its complications. Therefore, it is recommended to perform an annual evaluation of cognitive function in patients with diabetes older than 65 years. Current guidelines still recommend the use of the Minimental State Evaluation Test (MMSE) as screening test, but it has a modest sensitivity and specificity for identifying mild cognitive impairment. This represents an important gap because patients with mild cognitive impairment are at risk of progressing to dementia. The neurocognitive diagnosis is based on complex neuropsychological tests, which require specifically trained personnel and are time consuming, making its routine incorporation into daily clinical practice unfeasible. Therefore, at present there are no reliable biomarkers to identify patients with type 2 diabetes at increased risk of d...
IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease... more IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developed countries, with its incidence growing parallel to the epidemics of obesity and type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are becoming a cornerstone in the management of cardiovascular health and some studies suggest the potential role in NAFLD. However, patients under treatment with SGLT2i are at risk of developing genitourinary fungal infections (GFIs). Moreover, both NAFLD and SGLT2i have a strong influence on the immune system, and therefore the risk of infections other than GFIs could be increased in NAFLD patients treated with SGLT2i. We aimed to examine the possible association of SGLT2i with infections and hepatic outcomes in NAFLD patients.MethodsWe conducted a case-control study including NAFLD patients with T2DM visited at the Liver Unit outpatient clinic from 2016 to 2021 with a minimum follow-up of 6 months by selecting...
Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been tradition... more Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been traditionally linked to one another. Recent studies suggest that NAFLD may be increasingly common in other types of diabetes such as type 1 diabetes (T1DM) and less frequently ketone-prone and Maturity-onset Diabetes of the Young (MODY) diabetes. In this review, we address the relationship between hyperglycemia and insulin resistance and the onset and progression of NAFLD. In addition, despite the high rate of patients with T2DM and other diabetes phenotypes that can alter liver metabolism and consequently develop steatosis, fibrosis, and cirrhosis, NALFD screening is not still implemented in the daily care routine. Incorporating a clinical algorithm created around a simple, non-invasive, cost-effective model would identify high-risk patients. The principle behind managing these patients is to improve insulin resistance and hyperglycemia states with lifestyle changes, weight loss, and new drug th...
Nonalcoholic steatohepatitis (NASH) is a leading cause of cirrhosis in western countries. Insulin... more Nonalcoholic steatohepatitis (NASH) is a leading cause of cirrhosis in western countries. Insulin resistance (IR), type 2 diabetes (T2D), and the polymorphisms patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 and transmembrane 6 superfamily member 2 (TM6SF2) rs58542926 are independent risk factors of NASH. Nevertheless, little is known about the interaction between IR and T2D with these polymorphisms in the pathogenesis of NASH and the development of advanced fibrosis. Thus, our study aimed to investigate this relationship. This is a cross-sectional study including NASH patients diagnosed by liver biopsy, at the Vall d’Hebron University Hospital. A total of 140 patients were included (93 T2D, 47 non-T2D). T2D (OR = 4.67; 95%CI 2.13–10.20; p < 0.001), PNPLA3 rs738409 and TM6SF2 rs58542926 polymorphisms (OR = 3.94; 95%CI 1.63–9.54; p = 0.002) were independently related with advanced liver fibrosis. T2D increased the risk of advance fibrosis on top of the two polymor...
Sarcopenic obesity has been associated with greater disability, morbidity and mortality. However,... more Sarcopenic obesity has been associated with greater disability, morbidity and mortality. However, at present, there are few studies regarding the role of sarcopenia in the evolution of the comorbidities associated with obesity in individuals less than 65 years of age. The pathogenesis is multifactorial and uncompletely ilucidated, but it seems that inflammatory mediators and insulin resistance play an important role. Although there is no clear consensus on its definition and diagnostic methods, there is a growing interest in finding biomarkers useful for the detection and monitoring. Regarding the treatment, a multimodal approach is recomended, based on dietary recommendations, exercise and eventually bariatric surgery.
Staged bariatric procedures in high risk patients are a common used strategy for morbid obese pat... more Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.
Background and aims Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperi... more Background and aims Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperimetry are useful and complementary tools for identifying mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D). The hypothesis is that RS and GF examine different neural circuits: RS depends only on the visual pathway while GF reflects white matter complex connectivity networks. The aim of the study is to shed light to this issue by examining the relationship of these two parameters with visual evoked potentials (VEP), the current gold standard to examine the visual pathway. Materials and methods Consecutive T2D patients > 65 years were recruited from the outpatient clinic. Retinal microperimetry (MAIA 3rd generation) and visual evoked potentials (VEP) (Nicolet Viking ED). RS (dB), GF (BCEA63%, BCEA95%) (MAIA) and VEP (Latency P100ms, Amplitude75–100 uV) were analyzed. Results Thirty three patients (45% women, 72.1 ± 4.6 years) were included. VEP parameters significan...
Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is... more Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters. Material and Methods: A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality. Results: Daytime sleepiness was higher in T2D than in control subjects (p=0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ?13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8-7.9, p=0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0-18.0) vs. 4 (0.0-12.0), p<0.001]. Conclusion: The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted
Additional file 2. Differences between participants coming from the Memory Clinic and those from ... more Additional file 2. Differences between participants coming from the Memory Clinic and those from the Open House Initiative. Description: Demographical, clinical and FBB-PET differences between participants coming from the Memory Clinic and those from the Open House Initiative. A T-test was used to analyse differences on age, years of education, MMSE scores, and global SUVR at v0. A Chi-Square test was employed to analyse differences on the distribution of females, APOE genotype, FBB-PET+ at v0 and converters to MCI at v2 between groups. *Statistical significance was set-up at p
Additional file 3. Matrix of correlations of retinal thickness in multiple retinal regions. Descr... more Additional file 3. Matrix of correlations of retinal thickness in multiple retinal regions. Description: Values over the diagonal line represent raw Peason's r correlations between retinal measurements. Values below the diagonal line represent Pearson's r correlations between retinal measurements adjusted by age, gender, years of education, APOE status and OCT image quality. Statistical significance was set-up at p
The prevalence of diabetes type 1 (T1D) in the world populations is continuously growing. Althoug... more The prevalence of diabetes type 1 (T1D) in the world populations is continuously growing. Although treatment methods are improving, the diagnostic is still symptom-based and sometimes far after onset of the disease. In this context, the aim of the study was the search of new biomarkers of the disease in red blood cells (RBCs), until now unexplored. The metabolomic and the lipidomic profile of RBCs from T1D patients and matched healthy controls was determined by NMR spectroscopy, and different multivariate discrimination models were built to select the metabolites and lipids that change most significantly. Relevant metabolites were further confirmed by univariate statistical analysis. Robust separation in the metabolomic and lipidomic profiles of RBCs from patients and controls was confirmed by orthogonal projection on latent structure discriminant analysis (OPLS-DA), random forest analysis, and significance analysis of metabolites (SAM). The main changes were detected in the levels ...
Introduction: In the context of obesity pandemic, the health care providers involved in the prima... more Introduction: In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy, and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present, there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic. Methods: We present a model of continuous, bilateral, and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system. Results: The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the managemen...
Introduction: A significant reduction in fat-free mass (FFM) following bariatric surgery (BS) has... more Introduction: A significant reduction in fat-free mass (FFM) following bariatric surgery (BS) has been reported, and adequate protein intake is recommended for FFM preservation. Current guidelines of nutritional management after BS recommend complex protein (CP) compounds. However, Roux-en-Y-gastric bypass (RYGB) has a negative impact on CP digestion, leading to protein malabsorption. At present, there is no data regarding the impact of early supplementation with short peptide-based (SPB) or hydroxy methylbutyrate (HMB)-enriched formulas on the evolution of the FFM after the BS. Aim: The aim of this study is to evaluate the effect of nutritional products based on CP, HBM-enriched, or SPB formulas on the FFM of patients that undergo RYGB. Material and methods: This is a prospective interventional study, including three groups of patients (according to the type of protein product) as candidates for BS, recruited between December 2021 and April 2022, matched by age, gender, and BMI. Al...
The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive im... more The presence of type 2 diabetes acts as an accelerator of cognitive impairment (mild cognitive impairment and later dementia), with a significant impact on the management of the disease and its complications. Therefore, it is recommended to perform an annual evaluation of cognitive function in patients with diabetes older than 65 years. Current guidelines still recommend the use of the Minimental State Evaluation Test (MMSE) as screening test, but it has a modest sensitivity and specificity for identifying mild cognitive impairment. This represents an important gap because patients with mild cognitive impairment are at risk of progressing to dementia. The neurocognitive diagnosis is based on complex neuropsychological tests, which require specifically trained personnel and are time consuming, making its routine incorporation into daily clinical practice unfeasible. Therefore, at present there are no reliable biomarkers to identify patients with type 2 diabetes at increased risk of d...
IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease... more IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developed countries, with its incidence growing parallel to the epidemics of obesity and type 2 diabetes mellitus (T2DM). Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are becoming a cornerstone in the management of cardiovascular health and some studies suggest the potential role in NAFLD. However, patients under treatment with SGLT2i are at risk of developing genitourinary fungal infections (GFIs). Moreover, both NAFLD and SGLT2i have a strong influence on the immune system, and therefore the risk of infections other than GFIs could be increased in NAFLD patients treated with SGLT2i. We aimed to examine the possible association of SGLT2i with infections and hepatic outcomes in NAFLD patients.MethodsWe conducted a case-control study including NAFLD patients with T2DM visited at the Liver Unit outpatient clinic from 2016 to 2021 with a minimum follow-up of 6 months by selecting...
Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been tradition... more Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) have been traditionally linked to one another. Recent studies suggest that NAFLD may be increasingly common in other types of diabetes such as type 1 diabetes (T1DM) and less frequently ketone-prone and Maturity-onset Diabetes of the Young (MODY) diabetes. In this review, we address the relationship between hyperglycemia and insulin resistance and the onset and progression of NAFLD. In addition, despite the high rate of patients with T2DM and other diabetes phenotypes that can alter liver metabolism and consequently develop steatosis, fibrosis, and cirrhosis, NALFD screening is not still implemented in the daily care routine. Incorporating a clinical algorithm created around a simple, non-invasive, cost-effective model would identify high-risk patients. The principle behind managing these patients is to improve insulin resistance and hyperglycemia states with lifestyle changes, weight loss, and new drug th...
Nonalcoholic steatohepatitis (NASH) is a leading cause of cirrhosis in western countries. Insulin... more Nonalcoholic steatohepatitis (NASH) is a leading cause of cirrhosis in western countries. Insulin resistance (IR), type 2 diabetes (T2D), and the polymorphisms patatin-like phospholipase domain-containing 3 (PNPLA3) rs738409 and transmembrane 6 superfamily member 2 (TM6SF2) rs58542926 are independent risk factors of NASH. Nevertheless, little is known about the interaction between IR and T2D with these polymorphisms in the pathogenesis of NASH and the development of advanced fibrosis. Thus, our study aimed to investigate this relationship. This is a cross-sectional study including NASH patients diagnosed by liver biopsy, at the Vall d’Hebron University Hospital. A total of 140 patients were included (93 T2D, 47 non-T2D). T2D (OR = 4.67; 95%CI 2.13–10.20; p < 0.001), PNPLA3 rs738409 and TM6SF2 rs58542926 polymorphisms (OR = 3.94; 95%CI 1.63–9.54; p = 0.002) were independently related with advanced liver fibrosis. T2D increased the risk of advance fibrosis on top of the two polymor...
Sarcopenic obesity has been associated with greater disability, morbidity and mortality. However,... more Sarcopenic obesity has been associated with greater disability, morbidity and mortality. However, at present, there are few studies regarding the role of sarcopenia in the evolution of the comorbidities associated with obesity in individuals less than 65 years of age. The pathogenesis is multifactorial and uncompletely ilucidated, but it seems that inflammatory mediators and insulin resistance play an important role. Although there is no clear consensus on its definition and diagnostic methods, there is a growing interest in finding biomarkers useful for the detection and monitoring. Regarding the treatment, a multimodal approach is recomended, based on dietary recommendations, exercise and eventually bariatric surgery.
Staged bariatric procedures in high risk patients are a common used strategy for morbid obese pat... more Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.
Background and aims Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperi... more Background and aims Retinal sensitivity (RS) and gaze fixation (GF) assessed by retinal microperimetry are useful and complementary tools for identifying mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D). The hypothesis is that RS and GF examine different neural circuits: RS depends only on the visual pathway while GF reflects white matter complex connectivity networks. The aim of the study is to shed light to this issue by examining the relationship of these two parameters with visual evoked potentials (VEP), the current gold standard to examine the visual pathway. Materials and methods Consecutive T2D patients > 65 years were recruited from the outpatient clinic. Retinal microperimetry (MAIA 3rd generation) and visual evoked potentials (VEP) (Nicolet Viking ED). RS (dB), GF (BCEA63%, BCEA95%) (MAIA) and VEP (Latency P100ms, Amplitude75–100 uV) were analyzed. Results Thirty three patients (45% women, 72.1 ± 4.6 years) were included. VEP parameters significan...
Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is... more Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters. Material and Methods: A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality. Results: Daytime sleepiness was higher in T2D than in control subjects (p=0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ?13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8-7.9, p=0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0-18.0) vs. 4 (0.0-12.0), p<0.001]. Conclusion: The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted
Additional file 2. Differences between participants coming from the Memory Clinic and those from ... more Additional file 2. Differences between participants coming from the Memory Clinic and those from the Open House Initiative. Description: Demographical, clinical and FBB-PET differences between participants coming from the Memory Clinic and those from the Open House Initiative. A T-test was used to analyse differences on age, years of education, MMSE scores, and global SUVR at v0. A Chi-Square test was employed to analyse differences on the distribution of females, APOE genotype, FBB-PET+ at v0 and converters to MCI at v2 between groups. *Statistical significance was set-up at p
Additional file 3. Matrix of correlations of retinal thickness in multiple retinal regions. Descr... more Additional file 3. Matrix of correlations of retinal thickness in multiple retinal regions. Description: Values over the diagonal line represent raw Peason's r correlations between retinal measurements. Values below the diagonal line represent Pearson's r correlations between retinal measurements adjusted by age, gender, years of education, APOE status and OCT image quality. Statistical significance was set-up at p
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